PubMed Health⌕ Search

Biomedical subjects

F Durity

Publications and source records attributed to F Durity.

16 recordsLinked to original sources

Education and information needs identified by patients and key family members prior to surgery for a skull base neoplasm: implications for practice.

Many patients with extensive skull base neoplasms poorly understand the nature of their problems. Therefore, education of patients and family members is an important component of care. Research has established the benefits of pre-operative education for other types of surgery and information seeking as an important method of coping. Yet in 184 references on skull base surgery (1996-1999), no case-based or research data that examined education and information needs prior to hospitalization for surgery was found. The investigators present findings from Phase 1 of a descriptive research study designed to determine the education and information needs perceived by patients and family members at their initial visit to the neurosurgeon and on admission to hospital. Data was collected, using interviews and a questionnaire, from 18 patients with skull base neoplasms and 15 key family members. The study findings provide insight into the experience of patients and families during a time period (prehospitalization) that has not been explored. Results indicate that key education needs of participants are related to the brain tumour and surgery. Findings reveal patient participants in contrast to family members had little in the way of information needs. Underlying and impacting the education and information needs is the theme of 'Hearing the News'. Relevance of the results to nursing practice in the pre-operative phase is addressed.

Adult↗

Gonadotrophin-secreting pituitary tumour: report and review.

A 34-year-old male with a pituitary adenoma was investigated and demonstrated to have hypersecretion of both gonadotrophins in the basal state. Immunocytochemical staining and electron microscopic examination were positive for tumour cells secreting FSH and LH. Presenting symptoms included visual disturbances, loss of libido, impotence, cold intolerance, frontal headaches, change in skin pigmentation and excessive weight gain. The patient denied alteration in hair distribution, had no acral features, galactorrhoea or gynaecomastia. Surgical extirpation resulted in complete amelioration of his symptoms over a three year follow-up period. Basal and stimulated pituitary function testing results returned to normal post-operatively. A review of the literature documents six other cases of pituitary tumour secreting both LH and FSH in the basal state. More commonly, the pituitary adenoma secretes FSH only. The literature is reviewed with regard to both types of tumour.

Adenoma↗

Clinical - radiological correlates in intracerebral hematomas due to aneurysmal rupture.

In this series of intracerebral hematomas from aneurysmal rupture, gathered from several neurosurgical services, certain morphological features were studied in detail. Patients with very large hematomas tended to have poor neurological grades on admission to hospital and their immediate discharge outlook was correspondingly poor. Ruptured middle cerebral and pericallosal artery aneurysms were relatively common causes of intracerebral hematomas. Patients with temporal lobe hematoma did relatively well; those with parietal hematoma did poorly. The larger the hematoma the less chance there was of developing cerebral vasospasm but the more likely was pre-operative brain herniation. The survival was more closely linked to size and location of the hematoma than to the location of aneurysm or the degree of midline shift.

Cerebral Hemorrhage↗

Experimental cerebral oligemia and ischemia produced by intracranial hypertension. Part 1: Pathophysiology, electroencephalography, cerebral blood flow, blood-brain barrier, and neurological function.

Cerebral blood flow, electrical activity, and neurological function were studied in rabbits subjected to either 15 minutes of oligemia (20 torr cerebral perfusion pressure) or complete cerebral ischemia produced by cisterna magna infusion. During oligemia, flow was reduced from 68.4 +/- 4.2 ml/100 gm/min to 26.3 +/- 4.4 (p less than .01), and during ischemia animals had no proven flow. By 5 minutes after oligemia or ischemia significant symmetrical hyperemia occurred and there was no evidence of the no-reflow phenomenon. The electroencephalogram became isoelectric significantly later and returned significantly sooner in oligemia than in ischemia. Oligemic animals had earlier and better return of neurological function than their ischemic counterparts, although postinsult hypocapnia improved functional recovery in both groups. These experiments do not support the concept that oligemia is a more severe insult than complete ischemia. In intracranial hypertension produced by this model, the no-reflow phenomenon does not occur.

Animals↗

Experimental cerebral oligemia and ischemia produced by intracranial hypertension. Part 2: Brain morphology.

The authors studied the morphological sequelae of 15 minutes of cerebral oligemia (20 torr cerebral perfusion pressure) and complete cerebral ischemia produced by raised intracranial pressure in rabbits. Ischemic cell change was present in five of seven ischemic animals; it was most extensive in the striatum and hippocampus, with only a few ischemic nerve cells in the thalamus and neocortex. The brains of control and oligemic animals were normal. These results indicate the following: 1) ischemia is a more severe insult than oligemia; 2) compression ischemia results in a pattern of damage that differs from that produced by other types of ischemia; and 3) the method used to reduce cerebral perfusion pressure is an important factor in determining the pattern and extent of brain damage produced.

Animals↗

Experimental cerebral oligemia and ischemia produced by intracranial hypertension. Part 3: Brain energy metabolism.

The authors studied the effect on cortical metabolites of intracranial hypertension produced by the infusion of mock cerebrospinal fluid into the cisterna magna in rabbits subjected to 15 minutes of cerebral oligemia (20 torr) or 15 minutes of complete ischemia. In both groups high-energy metabolites were exhausted within the first 5 minutes of the 15-minute insult. Significant recovery of the high-energy intermediates occurred within 15 minutes of reperfusion, well before return of electroencephalogram (EEG) activity. Continued reperfusion, during which electrical activity and function were returning, brought only moderate improvement in energy metabolites. In contrast, severe lactic acidosis persisted at least 15 minutes after insult, but was reduced by the time EEG activity returned. At no time were there striking differences in metabolites between the oligemic and ischemic groups. These results indicate that recovery in general, and the significantly earlier recovery of oligemic as compared to ischemic animals, cannot be explained on the basis of energy supply. Whether the persistence of lactic acidosis is an important factor limiting return of function requires further study.

Adenosine Triphosphate↗

Effect of phenoxybenzamine on cerebral blood flow and metabolism in the baboon during hemorrhagic shock.

Experiments were performed on 2 groups of baboons anesthetized with Sernylan. One group served as control and the other was premedicated with 5 mg/kg phenoxybenzamine (PBZ). A 2-step hypovolemic shock model was used followed by retransfusion of the shed blood. Cerebral blood flow was measured by the 133Xe clearance method. Arterial and cerebral venous samples were taken and analyzed for blood gases as well as glucose and lactate content. The cerebral metabolic rates of oxygen, glucose, and lactate were calculated. In addition, the effect of CO2 inhalation was studied before shock was induced. PBZ produced no effect on either CBF or the flow response to CO2 prior to bleeding. PBZ pretreatment prevented the fall in cerebral blood flow and CMRO2 produced by systemic hypotension due to bleeding. Lactic acid showed no evidence of change either in production or uptake by the brain during the experimental procedure. The cerebral metabolic pathway of glucose, however, seemed to be affected by PBZ both before and during shock.

Animals↗

A monitoring and trending system and intracranial pressure.

A prototype of a portable microprocessor-based system for monitoring and displaying intracranial pressure, systemic arterial pressure, and cerebral perfusion pressure data has been developed. This system reduces the data for long-term logging and subsequent display as a trend plot and an array of computed histograms. Included in the system is the capability of presetting alarms to identify and alert clinical staff to potentially hazardous conditions. An initial technical and clinical evaluation indicates that the objective of improving patient care while controlling capital and operating costs has been met. The alarm system and the trended data display can be used to routinely detect conditions that previously were not immediately identified because of inherent limitations in currently available equipment. The precise minute-to-minute and retrospective evaluation of clinical events is now facilitated by a consistent, concise record and analysis of ICP and related data.

Central Nervous System Diseases↗